Ideas for monitoring medical marijuana
As of January, 20 states have legalized medical but not recreational marijuana, and nine states (plus Washington, D.C.) have further legalized it for recreational purposes. Insofar as we can use these states to predict the consequences of State Question 788, let me offer a few details and suggestions.
First, according to the Journal of the Society for Prevention Research, states that have approved medical marijuana did not see a rise in marijuana consump- tion among teens and adults 12-25. Why is that? Most high school and college students know, by word of mouth, where to buy marijuana. By contrast, adults 26 and older have far less access and tend to be more risk averse. Hence, there is an average rise in use from 5.1 percent to 6.5 percent among adults 26 and older in medical marijuana states, which is roughly on par with their medical marijuana enrollment statistics: Arizona (1.7 percent), Connecticut (0.7), Hawaii (1.4), Montana (2.1), etc.
Nevertheless, this doesn’t mean that our legislators should simply let SQ 788 pass without enacting any controls. Given that proponents of SQ 788 base their arguments on marijuana’s medical benefits, they should be willing to support legislative action that more carefully distinguishes between legitimate medical use versus pretexts for recreational use. The challenge is in finding the right way to do this.
The approach taken by Senate Bill 1120 is to list specific medical conditions such as neuropathic pain, multiple sclerosis based spasticity, and nausea from chemotherapy. The difficulty with this is three-fold. First, it does not fully cohere with the findings of current research (e.g. Crohn’s disease, fibromyalgia). Second, it does not provide for the results of emerging research (e.g. rheumatoid arthritis, ALS). Third, it has our government interfering in our medical treatment. While it is appropriate for legislators to set standards for safety and efficacy, they should allow medical science, the judgment of physicians and the needs of patients to determine care.
Accordingly, I have three recommendations. First, let medical science and not our politicians tell us what marijuana is good for. Have SB 1120 define a “qualifying condition” as “a painful or debilitating medical condition for which there have been controlled, randomized studies published in peer-reviewed medical journals with an impact factor of 2.0 or greater, showing an improvement in symptoms of at least 20 percent, with a p-value of .05 or better.” Second, SB 1120 is unclear about the difference between vaporizing vs. smoking marijuana. Vaporizing gassifies rather than burns (combusts) the material. Further, vaporizing is a more medically appropriate route of administration versus oral ingestion. Not only will it relieve pain, nausea, etc. far more quickly, but also, because CBD has very low oral bioavailability, eating marijuana tends to accentuate THC’s effects, including anxiety, paranoia and even hallucinations.
Third, over the past decade, considerable effort has gone into developing strains with specific CBD:THC ratios. Because CBD counteracts the psychotropic effects of THC, strains with high CBD to THC ratios offer commensurate medical benefits while limiting its recreational appeal. Some of these strains include: “Avidekel” with a CBD:THC ratio of 15:1, “Lilly CBD” (3:1), and “Harlequin” (5:2). Given that the existing black market trade in marijuana has CBD to THC ratios much more conducive to recreational use, by limiting sales and cultivation to only those strains with high CBD to THC ratios, there will be much less misuse and reason for diversion.